What is the term for referred pain to the shoulder due to gallbladder (gall bladder) disease?

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Last updated: March 18, 2025 • View editorial policy

From the Guidelines

Referred pain to the shoulder due to gallbladder disease is called Kehr's sign, although it is more commonly associated with splenic rupture, the phenomenon of referred shoulder pain due to gallbladder disease is a result of the irritation of the phrenic nerve by the inflamed gallbladder, as described in various studies on abdominal pain and anatomy 1.

Mechanism of Referred Pain

The mechanism behind this referred pain involves the irritation of the diaphragm by the inflamed gallbladder, which in turn irritates the phrenic nerve. This nerve shares the same nerve roots (C3-C5) as the nerves supplying the shoulder, leading to the brain interpreting the pain as coming from the shoulder rather than the gallbladder. This phenomenon is a classic example of referred pain, where discomfort is perceived at a location different from the actual source of the problem.

Clinical Significance

Kehr's sign, or the phenomenon of referred shoulder pain due to gallbladder disease, is an important clinical indicator that can help diagnose gallbladder conditions, particularly acute cholecystitis or biliary colic. It is essential for clinicians to recognize this sign, as it can aid in the timely diagnosis and treatment of gallbladder diseases, potentially reducing morbidity and mortality associated with these conditions. The use of ultrasound (US) as the first choice of investigation for biliary symptoms or right upper quadrant abdominal pain, as recommended by the American College of Radiology 1, can help confirm the diagnosis and guide appropriate management.

Diagnosis and Management

In patients presenting with right shoulder pain and suspected gallbladder disease, a thorough clinical evaluation, including imaging studies like US, is crucial for accurate diagnosis. The presence of gallstones, gallbladder wall thickening, or other abnormalities on US can support the diagnosis of gallbladder disease as the cause of the referred shoulder pain. Management of the underlying gallbladder condition, whether through medical or surgical means, is essential to alleviate the pain and prevent potential complications.

From the Research

Referred Pain to the Shoulder due to Gallbladder Disease

The term for referred pain to the shoulder due to gallbladder disease is not explicitly stated in the provided studies. However, the studies do mention that gallbladder disease can cause referred pain to the right shoulder or right supraclavicular region 2, 3.

Characteristics of Referred Pain

  • Referred pain to the right shoulder or right supraclavicular region is a common symptom of gallbladder disease 2
  • This type of pain is often associated with other symptoms such as nausea, vomiting, and right upper quadrant abdominal pain 2, 4, 5
  • The pain can be sudden in onset and may be triggered by eating or other factors 4, 5

Diagnosis and Treatment

  • Ultrasonography is the initial imaging choice for detecting gallstones and acute cholecystitis 4, 5
  • A hepatobiliary iminodiacetic acid (HIDA) scan can be used to evaluate for cholecystitis in patients with negative or equivocal ultrasound findings 5
  • Laparoscopic cholecystectomy is the treatment of choice for most patients with biliary colic or acute cholecystitis 4, 5

References

Guideline

acr appropriateness criteria<sup>®</sup> right upper quadrant pain.

Journal of the American College of Radiology, 2019

Research

Cholelithiasis: Presentation and Management.

Journal of midwifery & women's health, 2019

Research

Gallstone Disease: Common Questions and Answers.

American family physician, 2024

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.